MEDICARE: WIVINE PILI BISOKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1306791611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WIVINE PILI BISOKA

Provider Business Mailing Address
First Line	:	15353 HOGBACK WAY
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83607-5786
Country	:	US
Telephone Number	:	208-794-2650
Fax Number	:

Provider Business Practice Location Address
First Line	:	8601 W EMERALD ST STE 160
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8297
Country	:	US
Telephone Number	:	208-992-6510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ WIVINE PILI BISOKA ” Practice Location

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